Blood pump with expandable cannula

ABSTRACT

A blood pump includes an impeller having a plurality of foldable blades and a cannula having a proximal portion with a fixed diameter, and a distal portion with an expandable diameter. The impeller can reside in the expandable portion of the cannula. The cannula has a collapsed condition for percutaneous delivery to a desired location within the body, and an expanded condition in which the impeller can rotate to pump blood. A flexible drive shaft can extend through the cannula for rotationally driving the impeller within the patient&#39;s body.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to U.S. Provisional Patent ApplicationSer. No. 61/222,236, filed Jul. 1, 2009, which is incorporated herein byreference in its entirety for all purposes.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This application relates to blood pumps such as left or rightventricular assist devices with an expandable impeller for treatment ofheart disease. Still more particularly, this application relates toexpandable cannulas for use in such blood pumps, and to other structuralfeatures of these devices.

2. Description of the Related Art

Heart disease is a major problem in society, and claims many lives peryear. After a heart attack, only a small number of patients can betreated successfully and non-invasively using medicines, such aspharmaceuticals. However, with sufficient mechanical assistance to theheart function, a majority of patients may recover from a heart attack,including those with cardiogenic shock.

In a conventional approach, a blood pump having a fixed cross-section issurgically inserted within the left ventricle of the heart and theaortic arch to assist the heart in its function. Surgical placement isrequired, since it is presently impractical or impossible topercutaneously insert a pump of the size needed for sustaining adequateblood flow. The object of the surgically inserted pump is to reduce theload on the heart muscle for a period of time, which may be as long as aweek, allowing the affected heart muscle to recover while healing in asubstantially unloaded state.

Surgical insertion, however, can cause additional serious stresses inheart failure patients. Accordingly, devices have been developed whichare capable of percutaneous insertion while at the same time providingan adequate amount of blood flow. Such devices, including thosedescribed in U.S. Pat. No. 7,393,181 and in U.S. Pat. No. 7,841,976, thedisclosures of which are hereby incorporated by reference herein, have asufficiently small diameter to be inserted percutaneously through afemoral artery, but may subsequently be expanded in diameter so as togenerate a sufficient sustaining blood flow.

SUMMARY OF THE INVENTION

The operation of the aforementioned percutaneous blood pumps have facedseveral challenges, including the leakage of blood through a guide wirelumen extending through the pump impeller, maintaining the blood pumpimpeller centered within the outer cannula as the cannula bends withinthe vascular system, retracting the blood pump into the insertion sheathfor removal from the human body, and designing and maintaining the shapeof the expandable portion of the cannula of the blood pump to optimizeperformance.

There exists a need for improvements to expandable blood pumps whichaddress all of the foregoing problems so as to improve overallperformance. The inventions disclosed herein address one or more ofthese and other needs.

In some embodiments, an apparatus for inducing motion of a fluidrelative to the apparatus is provided. The apparatus can include anelongated cannula having a proximal portion and a distal portion, theproximal portion including a conduit having a fixed diameter, and thedistal portion including an expandable portion having a diameterexpandable to a diameter greater than the fixed diameter. The apparatuscan also include an impeller positioned in the elongated cannula andhaving a deployed configuration and a stored configuration.

The impeller can include a hub and a passageway extending through thehub between a first end and a second end. A valve can be positioned inthe hub. The valve can have a first condition for occluding flow of afirst fluid through the passageway from the first end to the second end,and a second condition for occluding flow of a second fluid through thepassageway from the second end to the first end.

In certain embodiments, a blade is supported by the hub, the bladehaving a proximal end attached to the hub and a distal end. In adeployed configuration of the impeller, the blade extends away from thehub. In a stored configuration of the impeller, the blade can becompressed so as to move the distal end of the blade towards the hub.

In some embodiments, of the apparatus for inducing motion of a fluid,the apparatus includes a vane assembly positioned in the expandableportion of the cannula distally of the impeller and having a deployedconfiguration and a stored configuration. The vane assembly includes avane hub and a plurality of vanes supported by the vane hub. Each of thevanes has a proximal end attached to the vane hub and a distal end. Thevanes, in the deployed configuration of the vane assembly, extend awayfrom the vane hub. In the stored configuration, the vanes of the vaneassembly are compressed so as to move the distal ends of the vanestowards the vane hub. The vane assembly can be connected to the impellerso that the vane assembly moves with the impeller in a longitudinaldirection of the elongated cannula and so that the vane assembly doesnot rotate with the impeller.

In other embodiments of the apparatus for inducing motion of a fluid,the expandable portion of the cannula has an inlet end, an outlet endand a diameter expandable to a diameter greater than the fixed diameter.The expandable portion includes a generally tubular reinforcing matrix,a layer of a first polymer at least partially coating an exterior of thereinforcing matrix and a layer of a second polymer different from thefirst polymer. The second polymer layer can be located in a regionadjacent the inlet end of the expandable portion.

In some embodiments, the apparatus for inducing motion of a fluidincludes an elongated cannula having a proximal portion and a distalportion. The proximal portion includes an expandable portion having agenerally tubular reinforcing matrix with a plurality of circumferentialrings each having an undulating pattern. The undulating pattern caninclude a plurality of apexes pointing toward the inlet end and aplurality of recesses pointing toward the outlet end. The undulatingpattern can also include a plurality of apexes pointing toward theoutlet end and a plurality of recesses pointing toward the inlet end.The matrix can also include a plurality of connectors. For example, theconnectors can connect the apices pointing toward the outlet end in oneof the rings to an adjacent one of the rings.

In other embodiments of the apparatus for inducing motion of a fluidrelative to the apparatus, an expandable portion of a cannula isprovided that has an inlet end, an outlet end and a diameter expandableto a diameter greater than the fixed diameter. The expandable portionincludes a generally tubular reinforcing matrix and a layer of a firstpolymer at least partially coating an exterior of the reinforcingmatrix. The reinforcing matrix includes a plurality of circumferentialrings each having an undulating pattern including a first plurality ofapices pointing toward the inlet end and defining a first plurality ofrecesses pointing toward the outlet end. Each circumferential ring canalso include a second plurality of apices pointing toward the outlet endand defining a second plurality of recesses pointing toward the inletend. At least one region of a second polymer different from the firstpolymer overlies the first polymer layer and connects one of the apicespointing toward the outlet end in one of the rings to at least one otherring.

Another aspect of the present invention provides a pump for pumpingfluid at a desired location. In accordance with one embodiment hereof,the pump includes a cannula having a compact state for insertion to thedesired location and an expanded state; an impeller positioned withinthe cannula and having a hub and a plurality of blades supported by thehub, the hub including a passageway extending between a first end and asecond end, each blade having a proximal end attached to the hub and adistal end, the impeller having a stored configuration and a deployedconfiguration; a valve positioned in the hub and having a firstcondition for occluding flow of a first fluid through the passagewayfrom the first end to the second end, and having a second condition foroccluding flow of a second fluid through the passageway from the secondend to the first end; and a drive mechanism for rotating the impeller inthe deployed configuration. The blades in the stored configuration ofthe impeller are compressed so as to move the distal ends of the bladestowards the hub, and the blades in the deployed configuration of theimpeller extend away from the hub. The cannula is in the expanded statewhen the impeller is in the deployed configuration.

A pump for pumping fluid at a desired location according to anotherembodiment hereof includes a cannula having a compact state forinsertion to the desired location and an expanded state; an impellerpositioned within the cannula and having a hub and a plurality of bladessupported by the hub, each blade having a proximal end attached to thehub and a distal end, the impeller having a stored configuration and adeployed configuration; a drive mechanism for rotating the impeller inthe deployed configuration; and a vane assembly positioned in thecannula and having a vane hub and a plurality of vanes supported by thevane hub, each vane having a proximal end attached to the vane hub and adistal end, the vane assembly having a stored configuration and adeployed configuration. The blades in the stored configuration of theimpeller are compressed so as to move the distal ends of the bladestowards the hub, and the blades in the deployed configuration of theimpeller extend away from the hub. The vanes in the stored configurationof the vane assembly are compressed so as to move the distal ends of thevanes towards the vane hub, and the vanes in the deployed configurationof the vane assembly extend away from the vane hub. The vane assembly isconnected to the impeller so that the vane assembly moves with theimpeller in a longitudinal direction of the cannula and so that the vaneassembly does not rotate with the impeller. The cannula is in theexpanded state when the impeller and the vane assembly are in thedeployed configuration.

A still further embodiment of a pump for pumping fluid at a desiredlocation according to the present invention includes a cannula having aninlet end, an outlet end, a compact state for insertion to the desiredlocation and an expanded state. The cannula includes a generally tubularreinforcing matrix, a layer of a first polymer at least partiallycoating an exterior of the reinforcing matrix and a layer of a secondpolymer different from the first polymer in a region adjacent the inletend of the cannula. An impeller is positioned within the cannula and hasa hub and a plurality of blades supported by the hub, each blade havinga proximal end attached to the hub and a distal end, the impeller havinga stored configuration and a deployed configuration. A drive mechanismis provided for rotating the impeller in the deployed configuration. Theblades in the stored configuration of the impeller are compressed so asto move the distal ends of the blades towards the hub, and the blades inthe deployed configuration of the impeller extend away from the hub. Thecannula is in the expanded state when the impeller is in the deployedconfiguration.

A pump for pumping fluid at a desired location according to yet anotherembodiment hereof includes a cannula having an inlet end, an outlet end,a compact state for insertion to the desired location and an expandedstate. The cannula includes a generally tubular reinforcing matrixhaving a plurality of circumferential rings each having an undulatingpattern including a plurality of apexes pointing toward the inlet endand defining a plurality of recesses pointing toward the outlet end, anda plurality of apexes pointing toward the outlet end and defining aplurality of recesses pointing toward the inlet end. The matrix furtherincludes a plurality of connectors, each connector connecting one of theapexes pointing toward the outlet end in one of the rings to an adjacentone of the rings. An impeller is positioned within the cannula and has ahub and a plurality of blades supported by the hub, each blade having aproximal end attached to the hub and a distal end, the impeller having astored configuration and a deployed configuration. A drive mechanism isprovided for rotating the impeller in the deployed configuration. Theblades in the stored configuration of the impeller are compressed so asto move the distal ends of the blades towards the hub, and the blades inthe deployed configuration of the impeller extend away from the hub. Thecannula is in the expanded state when the impeller is in the deployedconfiguration.

Yet a further embodiment of a pump for pumping fluid according to thepresent invention includes a cannula having an inlet end, an outlet end,a compact state for insertion to the desired location and an expandedstate. The cannula includes a generally tubular reinforcing matrix and alayer of a first polymer at least partially coating an exterior of thereinforcing matrix, the reinforcing matrix including a plurality ofcircumferential rings each having an undulating pattern including aplurality of apexes pointing toward the inlet end and defining aplurality of recesses pointing toward the outlet end, and a plurality ofapexes pointing toward the outlet end and defining a plurality ofrecesses pointing toward the inlet end. At least one region of a secondpolymer different from the first polymer overlies the first polymerlayer and connects one of the apexes pointing toward the outlet end inone of the rings to at least one other ring. An impeller is positionedwithin the cannula and has a hub and a plurality of blades supported bythe hub, each blade having a proximal end attached to the hub and adistal end, the impeller having a stored configuration and a deployedconfiguration. A drive mechanism is provided for rotating the impellerin the deployed configuration. The blades in the stored configuration ofthe impeller are compressed so as to move the distal ends of the bladestowards the hub, and the blades in the deployed configuration of theimpeller extend away from the hub. The cannula is in the expanded statewhen the impeller is in the deployed configuration.

Yet another embodiment described herein is directed to a method ofcompressing a percutaneous blood pump. This method can include providinga percutaneous blood pump that can include a non-expandable retainersheath and a cannula having an expandable portion. The expandableportion of the cannula can include one or more guidance aids. Thismethod can subsequently include using the one or more guidance aids toadvance a proximal portion of the expandable portion of the cannula intoa distal portion of the retainer sheath.

Another embodiment described herein is directed to a method ofcollapsing an expandable pump. This method can be used, for example, forpreparing a percutaneous blood pump for insertion into a patient. Thismethod can include providing a percutaneous blood pump that can includean expandable distal portion having a proximal end, a distal end, atubular matrix extending between the proximal and distal ends, animpeller disposed within the duct between the proximal and distal ends,and a sheath. In some embodiments, the sheath can have a generallynon-expanding distal portion. For example, the sheath can be configuredto have a substantially constant cross-section in the absence of aradially outwardly directed force. In some arrangements involvingfunnel-less deployment and retraction, there can be some deformation ofthe sheath while still achieving the benefits of minimizing potentialpooling of blood. This method can also include providing relative motionbetween the distal portion of the sheath and the proximal end ofexpandable portion such that the distal portion of the retainer sheathapplies a radially inward force to induce radial collapse of a distalregion of the tubular matrix to facilitate collapse of the expandableportion into the sheath.

In one technique, collapse of a distal region is facilitated byproviding a guidance aid coupled with the expandable portion, e.g., ator adjacent to a proximal end of the expandable portion to assist in thecollapse of the expandable portion. The guidance aid can be anystructure that locally stiffens a portion of the expandable portion ofthe duct (e.g., a proximal portion or axially extending regions, asdiscussed below). In one example, the guidance aid can be a connectorassociated with the expandable portion. In another example, the guidanceaid can be a region of elastomeric material.

In another method for preparing a pump system, the system is providedwith a lumen that can be selectively opened and closed to enable theguidewire to be received in the lumen. For example, the lumen caninclude a flow regulator that includes a blocking member and a surfacethat is adapted to mate with the blocking member, such that upon suchmating the flow of a fluid is regulated (e.g., limited or completelyprevented). In some embodiments, the blocking member and mating surfacecan be engaged to provide a seal against flow of fluids proximally inone more and/or distally in another mode within the lumen. The blockingmember can be disengaged to permit the guidewire to pass through theflow regulator such that the guidewire is disposed both proximally anddistally of, e.g., directly across, the flow regulator. In oneembodiment, the flow regulator is disposed in a hub of the pump systemand the flow regulator is disengaged by deforming the hub and displacingthe blocking member into a deformed volume of the hub.

In another method for preparing a pump system, the system is providedwith a duct and a device positioned within the duct for inducing axialflow of blood through the duct. The duct can be a flexible member. Inone embodiment, the duct is expandable to enlarge the flow carryingcapacity of the pump system. In one embodiment, the duct is collapsibleto facilitate lower profile delivery, e.g., entry into a fluid systemthrough a small aperture. The duct can be collapsible to a deliveryconfiguration and expandable to an operating configuration. In someembodiments, the duct can be buttressed by one or more members thatextend transversely to the flow direction in the duct. The member(s)have a transverse profile, which can be a radial length from an endadjacent to a central zone of the duct to an opposite end or which canbe a circular circumference defined by the radial length between theends of the members. In one embodiment, the members are configured asvanes that are rigid enough to substantially maintain the inner surfaceof the duct away from the flow inducing device, but are collapsible tofacilitate crossing of the pump system through an aperture smaller thanthe transverse profile of the vanes. In one technique for preparing thepump for insertion through the small aperture, the buttressing members(e.g., vanes) are collapsed by a constraining structure, for example bycircumferentially wrapping the members about a longitudinal axis of theduct and holding the members in the circumferentially collapsed state.

Further embodiments concern various methods of manufacturing theapparatus and pumps discussed above. Other embodiments are directed tomethods of treating a patient, such as by performing one or more methodsteps within the body of a patient with the pumps and apparatusesdescribed herein.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete appreciation of the subject matter of the inventions andthe various advantages thereof can be realized by reference to thefollowing detailed description, in which reference is made to theaccompanying drawings in which:

FIG. 1 is a perspective view of one embodiment of a blood pump accordingto the present invention;

FIG. 2A is a side elevational view of one embodiment of the impellerportion of the blood pump of FIG. 1;

FIG. 2B is a partial side elevational view of one embodiment of acannula in which the impeller of the blood pump of FIG. 1 operates;

FIG. 2C is a partial longitudinal cross sectional view of one embodimentof an optional retainer sheath for use with the blood pump of FIG. 1;

FIG. 3 is a perspective view of one embodiment of an expandable portionof the cannula shown in FIG. 1, the expandable portion being illustratedin the deployed state;

FIG. 4 is an enlarged perspective view of one embodiment of a dischargeor proximal end of the expanded cannula having a hexagonal mesh;

FIG. 5 is an enlarged perspective view of one embodiment of the inlet ordistal end of the expanded cannula showing a guide wire disposedtherein, the guidewire having a distal tip;

FIGS. 6A and 6B are side elevational views of the expandable portion ofthe cannula of the blood pump of FIG. 1 in stored and deployedconfigurations, respectively;

FIGS. 7A and 7B are longitudinal, highly schematic views of oneembodiment of the blood pump of FIG. 1 in the deployed and storedconfigurations, respectively, showing system components;

FIG. 8A is a partial longitudinal cross sectional view of the blood pumpof FIG. 1 in a deployed configuration;

FIG. 8B is a partial longitudinal cross sectional view of the blood pumpof FIG. 1 in a retracted position;

FIG. 9 is a highly schematic view showing the blood pump of FIG. 1deployed in a patient;

FIG. 10A is a schematic view of the impeller of FIG. 2A, furtherincluding a ball check valve;

FIG. 10B is an enlarged partial cross sectional view of the impeller ofFIG. 2A showing a manufacturing state of the ball check valve;

FIG. 10C is an enlarged partial cross sectional view of the impeller ofFIG. 2A showing the ball check valve after manufacturing has beencompleted;

FIG. 10D is an enlarged partial cross sectional view showing a guidewire passing through the ball check valve of FIG. 10C;

FIG. 11 is a perspective view of a blood pump in a deployedconfiguration, showing one embodiment of an inlet guide vane assembly;

FIG. 12 is an enlarged partial side elevational view of the impeller andthe inlet guide vane assembly of FIG. 11;

FIG. 13A is an enlarged, highly schematic elevational view showing atechnique for stiffening an inlet end of an expandable portion of anexpandable cannula;

FIG. 13B depicts a mandrel that can be used when making a cannula havingan expandable portion having one or more coatings;

FIG. 13C shows an expandable portion of a cannula that includes a coatedand stiffened inlet portion;

FIG. 13D is a schematic cross sectional view of the coated and stiffenedinlet portion of FIG. 13C;

FIG. 14A shows highly schematic side views of different mesh designs;

FIG. 14B shows a highly schematic side view of a mesh design;

FIG. 14C depicts a material that can be incorporated into an expandableportion of a cannula and a main body;

FIG. 15A shows a partial schematic view of a mesh design that includes aconnector adjoining adjacent circumferential rings;

FIG. 15B shows a highly schematic side view of a mesh design useful tofacilitate retraction of the expanded cannula into a sheath;

FIG. 16 shows a highly schematic view of an alternate embodiment of amesh design useful to facilitate retraction of the expanded cannula intoa sheath; and

FIG. 17 shows a design of the expanded cannula useful to facilitateretraction into a sheath.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

I. Apparatus

A blood pump 10 according to the present invention has variousapplications within the human body, including as a left ventricle assistdevice, as a right ventricle assist device, for supplementing blood flowto organs, and the like. Referring to FIGS. 1 and 2A-C, blood pump 10can include three main components, a rotatable impeller 20; a cannula 40in which the impeller 20 resides; and a retainer sheath 60 overlying thecannula 40. Although each of these parts will be described generallybelow, blood pump 10 can include any or all of the structuralarrangements and features described in U.S. Pat. No. 7,841,976 thedisclosure of which is hereby incorporated by reference herein.

A. Impeller

Impeller 20 includes a hub 22 and a plurality of blades 24. Blades 24can be foldable against hub 22 so as to reduce the cross-sectional sizeof impeller 20 for percutaneous insertion into the body. Once impeller20 has been located in a desired position, blades 24 can be expandedaway from hub 22 using the stored potential energy of the folded bladesso as to place impeller 20 in operation for pumping blood. A rotatabledrive shaft 26 couples hub 22 to a motor (not shown) that can be locatedoutside of the patient, thereby imparting a rotational drive to theimpeller. Drive shaft 26 can have a substantially rigid portion 28 atits distal end which is connected to impeller 20 (see FIG. 8 a), and asubstantially flexible portion 30 (see FIG. 9). In some embodiments, thesubstantially flexible portion 30 extends along a majority of the lengthof the drive shaft 26. Advantageously, this flexibility can promote easeof the delivery of the pump 10 into a patient's anatomy. The flexibleportion 30 can be formed from a metal or polymer braid which is easilybendable, or from a composite braid to reduce heating from friction asdrive shaft 26 rotates. The flexible portion 30 of the drive shaft canbe housed within a flexible tube 32 which supports the flexible portionand maintains its shape as it is driven rotationally. Advantageously, aflexible portion 30 formed from a composite braid can have a generallysmooth outer surface, thus reducing friction between flexible portion 30and flexible tube 32. The flexible tube 32 can be formed from aconventional flexible biocompatible tubing, including polymer tubing,coiled metal tubing and the like. In one embodiment, the flexible tube32 is preferably formed from a polymer, such as polytetrafluorethylene.The proximal end of drive shaft 26 can be connected to the motor forrotating the drive shaft and impeller 20. Alternatively, drive shaft 26can be omitted, and electric or fluid power for rotating impeller 20 canbe provided through a rotor/stator assembly positioned proximally of theimpeller (e.g., near the distal end of the blood pump 10, in the patientwhen deployed).

Drive shaft 26 and the hub 22 of impeller 20 can each be formed with aninternal lumen 70 to allow a guide wire 72 to pass therethrough.Together, lumen 70 and guide wire 72 can assist in positioning bloodpump 10 within the patient, though a guidewire may not be necessary indelivering or positioning the blood pump 10. Guide wire 72 may be wirewound and can have an outer diameter in the range of from about 0.305 mm(0.012 in) to about 0.889 mm (0.035 in) and in one embodiment can have aJ tip 74 which facilitates navigation of the tortuous arterial pathwayfrom a peripheral (e.g., the femoral) insertion site to the cardiac leftventricle chamber when used as a left heart assist device. Guide wire 72can have one or more additional distal features, such as a sphericalshape, or a valve plug 76 to plug a hole in impeller 20 (or other distalstructure that is in fluid communication with the lumen 70) afterwithdrawal of the guide wire 72.

FIGS. 8A and 8B show that the rigid portion 28 of drive shaft 26 can besupported by one or more bearings 80 retained in a bearing housing 84. Asaline solution can be directed into bearing housing 84 through internallumen 70, and the bearing unit end seal 86 can be dimensioned so that avery small quantity of clean saline solution is infused into the patient(approximately 1-2 cc/hr). This fluid flow helps clean impeller 20 anddampens drive shaft vibrations. The fluid flow can also prevent bloodfrom entering bearing housing 84 and compromising its operation andlife. If the density of the rigid portion 28 of drive shaft 26 isapproximately the same as that of the saline solution or otherintroduced fluid, most of the vibration can be damped. The rigid portion28 of drive shaft 26 can be formed from carbon or other fiber andpolymer composite which has a lower density than metal and more closelymatches the density of the saline solution. Other lower density driveshafts and/or other higher density fluids can be used for vibrationdamping. The saline solution or other fluid can be introduced to bearinghousing 84 through openings 88 in hollow drive shaft portion 28.

1. Check Valve Arrangements & Methods of Manufacture

In a preferred arrangement, impeller 20 can be provided with a ballcheck valve 100, as shown in FIG. 10A, for preventing leakage of fluidthrough lumen 70. As shown in FIG. 10C, check valve 100 includes aspherical ball 102 having a first diameter, positioned within aspherical cavity 104 having a diameter which is greater than the firstdiameter so that ball 102 is freely movable within the cavity. Dependingupon the fluid pressure differential in the lumen 70 of impeller 20,ball 102 will be pushed against a structure to prevent flow, such as adistal valve seat 106 or a proximal valve seat 108 between cavity 104and lumen 70. That is, when the pressure of the saline flow distally oroutwardly through lumen 70 is greater than the pressure of the bloodflow proximally or inwardly through lumen 70, ball 102 will be pushedagainst distal valve seat 106 to prevent the flow of saline out throughimpeller 20. On the other hand, when the pressure of the blood flowinwardly through lumen 70 is greater than the pressure of the salineflow outwardly through lumen 70, ball 102 will be pushed againstproximal valve seat 108 to prevent the flow of blood into the interiorof drive shaft 26.

In order for check valve 100 to operate properly, ball 102 should have adensity that is less than the density of the fluid (either blood orsaline) within cavity 104 so that the ball is not thrown outwardly bycentrifugal forces when impeller 20 is rotated. When formed with anappropriate density, ball 102 will self-center during impeller rotationand will be pushed against either valve seat 106 or valve seat 108depending upon the pressure differential in cavity 104. Moreover, anappropriately designed check valve 100 will have little impact on thebalance and stiffness of impeller 20.

Despite the presence of check valve 100 in the path of lumen 70, guidewire 72 is still able to pass through the lumen to enable blood pump 10to be advanced over the guide wire 72 for placement at the desiredlocation within the patient. In that regard, impeller 20 is preferablyformed from a flexible, elastic material which can readily be deformedand which will return to its original shape once the deformation forcehas been removed. Thus, by forcing ball 102 to one side of lumen 70,such as through the use of a tapered pin or similar device, impeller hub22 will deform, providing a clear path through lumen 70 for guide wire72. In one embodiment, guide wire 72 can include a tapered and/or angleddistal tip 144 which helps to push ball 102 to one side of the lumen 70,as shown in FIG. 10D. As a result of the deformation of hub 22, guidewire 72 is able to pass through check valve 100 with a minimum amount offriction so that blood pump 10 can be easily advanced over the guidewire 72. Once blood pump 10 is properly positioned and guide wire 72 isremoved, hub 22 will return to its original shape and check valve 100will operate normally.

One technique for forming check valve 100 is to coat ball 102 with athin layer of a water soluble wax or similar material. The coated ballcan then be supported in a mold, such as by attaching a pair of axiallyaligned rods having a small diameter to either side of the wax coatedball, and impeller 20 molded around it, forming the structure shown inFIG. 10B. After impeller 20 has been removed from the mold, the waxlayer can be removed from ball 102 by flushing with water to release theball for free movement within cavity 104.

B. Cannula

As shown in FIG. 3, cannula 40 has a non-expandable portion 42 at itsproximal end and an expandable portion 44, in which impeller 20 resides,at its distal end. Preferably, expandable portion 44 is movable betweena collapsed or stored configuration which retains blades 24 of theimpeller in the folded condition, as shown in FIG. 6A, and an expandedor deployed configuration, as shown in FIG. 6B, which permits the bladesto move away from hub 22 and into the use condition or operation stateof the impeller 20. When used as part of a blood pump, expandableportion 44 in the deployed configuration can be in the range of fromabout 10 cm to about 50 cm long with a diameter in the range of fromabout 5 mm to about 15 mm. In the stored configuration, expandableportion 44 can have a diameter in the range of from about 2 mm to about8 mm, allowing non-surgical insertion of blood pump 10 into a humansubject through a superficial blood vessel, such as a femoral artery.The larger deployed diameter allows for higher fluid flow rates afterinsertion, and reduced friction pressure losses compared with anon-surgically inserted blood pump having a non expandable cannula.

The length of the expandable portion 44 can vary over a wide range. Insome embodiments the expandable portion 44 can have a length from inlet52 to outlet 54 that extends from a chamber of a patient's heart, suchas a left ventricle 500, to a position proximal of the patient's aorticvalve, such as the ascending aorta 505, as shown in FIG. 9. For example,expandable portion 44 can have a length in the range of from about 3inches to about 4 inches. In other embodiments the expandable portion 44can have a length from inlet 52 to outlet 54 that extends from a chamberof a patient's heart, such as a left ventricle 500, to a position in thepatient's descending aorta. For example, expandable portion 44 can havea length in the range of from about 9 inches to about 11 inches.

1. Impeller Housings for Compressed and Deployed States

Optionally, cannula 40 can have a storage housing 46 for storingimpeller 20 when the impeller 20 is in the stored state, as shown inFIGS. 8A-B. Storage housing 46 can be non-expandable. As describedherein, storage housing 46 can move axially in a proximal direction todeploy the impeller 20, as shown in FIG. 8A, and can move axially in adistal direction to store the impeller 20, as shown in FIG. 8B. In otherembodiments, the impeller 20 can be stored in the expandable portion 44of cannula 40, which can expand for deployment of the impeller 20. Inthese embodiments, there may not be a difference in the relative axialuse (e.g., deployed) location and the relative axial stored location ofimpeller 20.

The expandable portion 44 of cannula 40 can be formed from a mesh 48having an elastomeric coating 50. As described below, mesh 48predominantly defines the radial stiffness and bending characteristicsof the expandable portion 44, while the elastomeric coating 50 enrobesthe mesh to form a continuous duct having a fluid-carrying capability.

Mesh 48 can be formed from a flexible material, such as a polymer,metal, any shape memory material, or other material, and can include amachined cylinder with laser cut voids, a matrix of woven wires orfilaments, or another configuration. The mesh can be in the form of ahexagonal cell matrix, or can include circumferential rings 51, as shownin FIGS. 14A-B. As depicted in FIG. 14C, mesh 48 can include a pluralityof circumferential rings with axial connectors 53. Circumferential rings51 predominantly control the radial characteristics, while axialconnectors 53 affect axial stiffness and bending performance. Any otherstructures can be used for mesh 48 which are capable of moving betweencollapsed and expanded configurations and providing the cannula withsufficient strength and stiffness in the expanded configuration. Asdescribed further herein, mesh 48 can include one or more connectors 55,as shown in FIGS. 15A-B.

In some embodiments, the pattern of mesh 48 can be generally uniformthroughout the expandable portion 44. In other embodiments, the patternof mesh 48 can be generally non-uniform, such as by providing at leastone region of enhanced or reduced mesh density in the expandable portion44. Advantageously, an expandable portion 44 according to thisembodiment can have varying structural characteristics along at least aportion of its length and/or circumference. It may be useful to stiffenthe expandable portion 44 adjacent to the inlet 52 or outlet 54. Thiscan be achieved by providing more connections between adjacent rings orby increasing the longitudinal density of the rings.

Although the non-expandable portion 42 of cannula 40 and mesh 48 can beformed from different materials, they preferably are formed from thesame material. In one arrangement, mesh 48 can be formed from the sametube as forms non-expandable portion 42. In this regard, a memory metalalloy, such as nitinol, is a preferred material for forming bothportions of cannula 40. In such arrangement, a constant diameter tube ofthe metal, having a metal thickness on the order of thousandths of aninch, for example, a thickness in the range of from about 0.005 inch toabout 0.018 inch can be cut using a laser so as to leave a meshstructure adjacent one end. A constant diameter tube of the metal,having a metal thickness of between about 0.0018 inch and about 0.005inch can be cut to leave a mesh structure adjacent one end in someembodiments. As shown in FIG. 14C, a material (e.g., a generally flatpiece of metal) can be cut so as to leave a mesh 48 structure adjacent afirst end and a non-expandable portion 42 adjacent a second end.Discharge struts 58 can connect mesh 48 to the non-expandable portion42. The material can then be formed into a constant-diameter cylinder.The constant-diameter mesh 48 section can then be expanded/contractedradially to the desired shape using a mandrel, and optionally a clampingmechanism can be used to ensure the mesh conforms to the mandrelgeometry. The material can be “shape set” to this configuration using,for example, heat treatment. Use of the laser-cutting and shape-settingsteps enables complicated geometric patterns to be formed from theconstant-diameter tube. The mesh diameter may be designed to benon-uniform to accommodate a certain anatomy or to achieve a certainhydrodynamic effect or for other reasons.

Once mesh 48 has been formed, elastomeric coating 50 can be applied tothe inner and/or outer surface of the mesh. Coating 50 (which can be,for example, biocompatible, corrosion resistant and/or flow improving)can be formed by a solution casting method, by spray application over amandrel or by other techniques known in the art, including forming thecoating as a separate tube, fitting it over the mesh and heat shrinkingit to produce a tight fit. An elastomeric polymer such as Elastane™ orBiospan™ can be used for coating 50, as can other polyurethanes andcopolymers thereof, or other polymers. The thickness of coating 50 canvary over a wide range. As shown in FIG. 13D, the thickness of coating50 can be generally equal to the thickness of mesh 48. In otherembodiments, the thickness of coating 50 can be greater than thethickness of mesh 48. In some embodiments, the thickness of coating 50can have a thickness in the range of from about equal to the thicknessof mesh 48 to about twice the thickness of mesh 48. In otherembodiments, mesh 48 can be embedded, encapsulated, or can havegenerally its entire surface area coated with coating 50. Mesh 48 andcoating 50 together provide a flexible, expandable portion 44 of cannula40 that is a conduit for fluid flow. Embedding or encapsulating mesh 48in coating 50 can advantageously minimize sources of turbulence in thefluid flow path, and can reduce irritation to a blood vessel wall byproviding a smooth outer surface. The expandable portion 44 of cannula40 can be generally cylindrical with a flow inlet 52 at its distal end45 and a flow outlet 54 at its proximal end 47. The portion betweeninlet 52 and outlet 54 is the expandable portion 44 of cannula 40. Mesh48 can extend the entire distance from distal end 45 to proximal end 47,and/or from inlet 52 to outlet 54. Inlet 52 can include an outward taperor flare 132 (FIG. 13A) to aid in fluid flow into the expandable portion44 of cannula 40. Taper 132 can be formed by the shaping of coating 50,or by the combined shaping of mesh 48 and coating 50.

Mesh 48 can be radially expandable in a way which imparts a minimallength change along the axial direction during radialexpansion/contraction. The expandable portion 44 of cannula 40 canradially expand using stored potential energy, and thus is preferably aself-expanding device.

The radial stiffness of the expandable portion 44 can be controlled bycontrolling the thickness of mesh 48 and the geometric density of themesh structure, which can vary along the length of cannula 40. Suchvariability is useful to match the cannula stiffness with thehydrodynamic loading imposed on blood pump 10, enabling a nearlyconstant radial deflection of the expandable portion 44 when operatingas a flow duct (wherein the hydrodynamic pressure varies along thelength). This is important in the region of the impeller 20 to provide asubstantially constant operational gap between the tips of blades 24 andthe inner diameter of portion 44 in the expanded condition.

Bending stiffness of the expandable portion 44 of cannula 40 is also acontrollable parameter that can vary axially. For example, wherecircumferential rings 51 and axial connectors 53 are used to form mesh48, the bending stiffness is predominantly controlled by the number andplacement of the axial connectors 53, but also depends on the stiffnessof the circumferential rings 51 and the stiffness of the elastomericcoating 50. The relative placement of the circumferential rings largelyaffects the radial stability of the expandable portion 44 duringbending. For example, as shown in FIGS. 14A-C, mesh 48 can have asubstantial amount of interleaving of adjacent circumferential rings 51.This configuration yields a very stable expandable portion 44 withrespect to radial buckling caused by a bending deflection. Conversely, amesh pattern with no interleaving yields an expandable portion 44 thatcan be prone to radial buckling during a bending deflection. Radialstiffness can be augmented via mesh thickness or mesh density. A densemesh exhibits greater radial stability than a less dense mesh.

As shown in FIGS. 14A-C, circumferential rings 51 can be configured withan undulating or sinusoidal pattern with a plurality of apexes pointingtoward the distal end 45 of expandable portion 44 of cannula 40 anddefining a plurality of recesses pointing toward the proximal end 47thereof, and a plurality of apexes pointing toward the proximal end 47of expandable portion 44 and defining a plurality of recesses pointingtoward the distal end 45 thereof.

FIG. 3 depicts expandable portion 44 of cannula 40 in the expandedstate. Inlet 52 of the expandable portion 44 can be provided with aplurality of inlet struts 56 which prevent large debris from enteringthe expandable portion 44 to obstruct flow. Similarly, outlet 54 of theexpandable portion 44 can be provided with a plurality of dischargestruts 58 or vanes (not shown in this figure) which act as stator bladesto remove swirl velocity from the flow discharged through outlet 54.Inlet struts 56 and discharge struts 58 can be part of mesh 48.Alternatively, discharge struts 58 can be formed with air foil typecross sections. Discharge struts 58 can connect the expandable portion44 of cannula 40 to the non-expandable portion 42 or to storage housing46. Preferably, non-expandable portion 42 discharge struts 58 and mesh48 can be formed as a single, continuous structure from the same tube.In a variant hereof, discharge struts 58 and mesh 48 can be laser cutfrom one tube, and this portion can then be attached to non-expandableportion 42 by welding or other attachment techniques. Inlet struts 56can also be formed from the same tube as mesh 48, discharge struts 58and non-expandable portion 42.

2. Controlling Tip Gap

The curvature of the aorta and the vascular geometry can cause theexpandable portion 44 of cannula 40 to bend axially during operation.This bending can be such that the tips of blades 24 approach and retreatfrom the cannula walls with each rotation of impeller 20, impairinghydrodynamic functioning and, if the blade tips actually contact thecannula walls, causing hemolysis. Therefore, in order to keep impeller20 substantially centered in the expandable portion 44 of cannula 40during operation, blood pump 10 can be provided with a stator vaneassembly 120, shown in FIG. 11, for preventing “cantilever” bending ofthe expandable portion about any one point to maintain consistentclearance between the impeller blade tips and the cannula wall. Statorvane assembly 120 can include a central hub 122 and a plurality ofstator vanes 124 projecting radially outward therefrom. The stator vanes124 can be made of an elastomeric material, such as those materialsdescribed herein as being suitable for impeller blades 24. Accordingly,stator vanes 124 can be foldable against hub 122 so as to not interferewith impeller 20 and expandable portion 44 achieving their fullycollapsed condition. Moreover, stator vane assembly 120 preferably hasabout the same packing volume as impeller 20 so as to only minimallyincrease the forces required to collapse blood pump 10 and maintain itin the collapsed condition. Upon expansion of expandable portion 44 andimpeller 20, stator vanes 124 will similarly expand. In their fullyexpanded condition, the free ends of the vanes 124 can contact the innerwall of expandable portion 44.

Referring to FIG. 12, stator vane assembly 120 can be mounted to thedistal end of impeller hub 22 at an axial distance away from theimpeller 20 so that it translates with impeller 20, but does not rotatewith the impeller 20. In that regard, stator vane assembly 120 caninclude a hollow sleeve 126 in hub 122 coupled to a thrust bearing 128.Friction between the tips of stator vanes 124 and the coating 50 ofexpandable portion 44 will resist any torque transferred through thrustbearing 128 and thereby prevent the vanes from rotating within thecannula. A lumen 130 extends axially through hub 122 and communicateswith lumen 70 in impeller 20 for slidably receiving guide wire 72.

In some embodiments, the lumen 130 is adapted to prevent fluid flow inat least one direction during at least one mode of operation. Forexample, the stator vane assembly 120 and/or the impeller 20 can beadvanced along a guidewire extending through the lumen 130 prior tobeing activated to pump blood. In some embodiments, the guidewire willbe removed before the pump is activated. In some cases, it is preferredthat flow of blood into the lumen 130 is controlled or prevented, whichcan be accomplished by positioning a seal within the lumen 130. In someembodiments, the lumen 130 can be adapted for flexible self-sealingguidewire penetration. In another embodiment, a guide wire is notnecessary for guiding the system, with the expandable portion 44 ofcannula 40 in a collapsed state, to the target site due to inherentflexibility of the system and steerability in traversing the anatomy.

In some embodiments hereof, stator vanes 124 can be oriented at an angleto the direction of blood flow into inlet 52 of expandable portion 44 ofcannula 40. Such orientation will induce a circumferential velocitycomponent to the incoming blood, imparting a pre-swirl to the blood flowbefore it reaches impeller 20 so as to increase the net change inangular momentum of the fluid and thereby allow greater power extractionto the blood flow by the impeller 20.

In use, impeller 20 is positioned in the expandable portion 44 ofcannula 40 such that stator vane assembly 120 is also positioned withinthe expandable portion 44. As expandable portion 44 deforms in thepatient's vasculature, any forces exerted on the cannula will betransmitted through stator vanes 124 and hub 122 to impeller hub 22,thereby keeping impeller 20 substantially centered within expandableportion 44.

3. Variable Stiffness Flow Duct

The hydrodynamic performance of blood pump 10 can potentially beimpaired by the flexibility of or damage to the expandable portion 44 ofcannula 40 at inlet 52. That is, any flapping or other deformation ofcoating 50 at inlet 52 can result in a greater pressure drop for a givenblood flow rate, and can also result in blood damage via hemolysisand/or thrombus formation. Accordingly, it is desirable to provideexpandable portion 44 with a stiffened region at inlet 52 whilemaintaining the overall flexibility of the remainder of the expandableportion 44 both to accommodate the patient's vascular geometry and tofacilitate the compressibility of the expandable portion 44 forpercutaneous insertion.

In view of the foregoing, some embodiments can use two differentpolymers to form the coating 50 of expandable portion 44. As shown inFIG. 13A, the mesh 48 at the inlet end of expandable portion 44 can bemasked with a wax, such as jeweler's wax 140 or some other high qualitywax or other masking material to prevent this portion of the mesh frombeing coated with any polymeric material. A first elastomeric polymersuch as Biospan™ or other flexible bio compatible polymer can then besolvent cast onto the entirety of expandable portion 44 to form coating50. A second elastomeric polymer such as Hapflex™ 598 or anotherflexible bio compatible polymer can then be solvent cast to form asecond coating 145 (e.g., generally in the shape of a ring) in theregion adjacent inlet 52 and/or in any region where structural stiffnessof coating 50 is desired. In some embodiments, the first elastomericpolymer is a relatively soft urethane and the second elastomeric polymeris a relatively stiff urethane. FIG. 13C depicts one embodiment of anexpandable portion 44 having a stiffened region adjacent inlet 52. Asshown in FIG. 13D, the stiffened region adjacent inlet 52 can include afirst inner coating 50 and a second outer coating 145. The thickness ofsecond coating 145 can vary over a wide range. As shown in FIG. 13D, thethickness of second coating 145 can be less than the thickness of firstcoating 50. In other embodiments, the thickness of second coating 145can be greater than or generally equal to the thickness of first coating50. In some embodiments, second coating 145 can have a thickness in therange of from about 0.5 times the thickness of first coating 50 to about1.5 times the thickness of first coating 50. In some embodiments, thesecond coating 145 can at least partially coat the mesh 48. A mandrel136 that can be used to coat expandable portion 44 in this manner isillustrated in FIG. 13B. In some embodiments, mandrel 136 can include amounting structure 142, which can act as a base to support the mandrel136.

4. Slideable Deployment of Impeller

FIGS. 8A and 8B show an embodiment of blood pump 10 having an axiallyslidable storage housing 46. As can be seen in these figures, bearinghousing 84 can have a reduced diameter portion 90 between its endshousing bearings 80. This reduced diameter portion thus defines alongitudinal space for sliding movement of an internal rib 94 defined byan indented annular channel 96 in storage housing 46. In use, after theexpandable portion 44 of cannula 40 has been expanded (although notshown in FIGS. 8A-B, these structures would be to right of thestructures shown, as illustrated in FIGS. 7A-7B), the impeller 20 can bereleased from a stored configuration to a deployed configuration byaxially sliding the storage housing 46 in a proximal direction (e.g.,away from the impeller 20). In the deployed condition shown in FIG. 8A,storage housing 46 has been moved proximally by the maximum extentpermitted by the engagement of internal rib 94 with a proximal shoulderof bearing housing 84, thereby revealing blades 24 of impeller 20 fordeployment. In the stored configuration shown in FIG. 8B, on the otherhand, storage housing 46 has been moved distally (e.g., over and towardthe impeller 20) to the maximum extent permitted by internal rib 94contacting a distal shoulder of bearing housing 84. In this position,the distal end of storage housing 46 surrounds blades 24 of impeller 20,retaining them in the stored configuration.

In some embodiments, the use of storage housing 46, as shown in FIGS.8A-B, allows for a greater degree of compaction of the pump 10. Forexample, in these embodiments, the impeller 20 and expandable portion 44can be axially displaced relative to each other when in the collapsed orstored configuration in retainer sheath 60. In one arrangement, theimpeller 20 is withdrawn to a position substantially entirely proximallyof the expandable portion 44 and is collapsed within the storage housing46. In this arrangement, the compaction of the expandable portion 44 isnot limited by the presence of the impeller 20 within the portion 44.Accordingly, a pump 10 that includes storage housing 46 can have anexpandable portion 44 with a diameter in the collapsed or storedconfiguration that is smaller than that of a pump 10 that does notinclude storage housing 46. Another benefit of the axial displacement ofthe structures that are compacted for delivery is that a device with alarger expanded size can be arranged with the same crossing profile as adevice that does not provide for axial displacement but is smaller whenexpanded. For example, in embodiments that include storage housing 46,the expandable portion 44 advantageously can be configured to have alarger diameter in the deployed configuration as compared to embodimentsthat lack storage housing 46. An expandable portion 44 having arelatively larger diameter in the deployed configuration can beadvantageous when a higher flow rate is desired.

C. Retainer Sheath and Retraction without Funnel

Blood pump 10 can be inserted into the patient's body using a sheathlessinsertion procedure. Such procedure can employ a retainer sheath 60having a distal portion 62 and a proximal portion 64, as shown in FIG.2C. Distal portion 62 has an inner diameter and length which aresufficiently sized to receive the expandable portion 44 of cannula 40and to hold the expandable portion, and with it impeller 20, in thecollapsed condition during percutaneous insertion of blood pump 10 intoand removal of blood pump 10 from a patient. The proximal portion 64 ofretainer sheath 60 can serve as the housing for the flexible tubing 32,the flexible portion 30 of drive shaft 26 and/or for non-expandableportion 42 of cannula 40. Retainer sheath 60 is highly flexible, but hassufficient radial strength to resist collapsing or kinking as blood pump10 is advanced to the desired deployment site. In a preferredembodiment, sheath 60 can be formed by a continuously coiled metal wirecovered with a polymer tube or coating.

In some embodiments, retainer sheath 60 can be non-deformable,non-expandable, and/or can have a generally fixed-diameter. For example,retainer sheath 60 can be configured to not be distally expandable atany point during the compression of the expandable portion 44. Inanother example, retainer sheath 60 can be non-deformable,non-expandable, and/or can have a generally fixed-diameter when theexpandable portion 44 is in its deployed configuration. In someembodiments, retainer sheath 60 can be distally deformable (e.g.,expandable) when subject to a load.

The drive motor rotates drive shaft 26 without rotating cannula 40 orretainer sheath 60. The operation of blood pump 10 can be controlled andmonitored by a control unit (not shown) which displays status andcontrols various functions. Sensors, such as a pressure sensor and flowrate sensor, can be affixed to various regions of the patient and/or toone or more locations on the blood pump 10.

As described herein, when the device is to be removed from a patient,the expandable portion 44 of the cannula 40 can be pulled into theretainer sheath 60. One or more guidance aids can be used to direct theexpandable portion 44 into the retainer sheath 60. Advantageously, theuse of a guidance aid, described further herein, can allow theexpandable portion 44 to be collapsed or compressed without the use ofan outward flare or funnel on the sheath. Mesh 48 of expandable portion44 can include a guidance aid that can be designed to facilitate theretraction of the expandable portion 44 into a low profile distalportion of the retainer sheath 60.

Referring to FIG. 15A-B, one embodiment of the guidance aid includes aconnector 55 joining adjacent circumferential rings 51 of mesh 48. Aconnector 55 can join a first ring 51 a to an adjacent second ring 51 bat a variety of different locations relative to the first and secondrings 51 a, 51 b. In one embodiment, a connector 55 can connect theouter apex of a first ring 51 a to a point on the second ring 51 b suchas the inner apex of the second ring 51 b or on a point along a side ofthe second ring 51 b. As shown in FIG. 15A, the first end 55 a ofconnector 55 can be joined to the outside apex of a firstcircumferential ring 51 a, while the second end 55 b of connector 55 canbe joined to a point along a side of the second circumferential ring 51b.

In another embodiment, the end 55 a of connector 55 can be joined to theoutside apex of one circumferential ring 51 a, while the end 55 b ofconnector 55 can be joined to the inside apex of the adjacentcircumferential ring 51 b, as shown in FIG. 15B. Connectors 55 can havea serpentine or flat coiled shape in order to maintain the flexibilityof expandable portion 44. The connections of connector ends 55 a to theoutside apexes of rings 51 prevent the apexes from catching on orinterfering with the end of retainer sheath 60 as expandable portion 44is withdrawn into the retainer sheath by constraining the apexes andinhibiting expansion of an individual ring 51. As shown in FIG. 15B,connector 55 can be connected to a circumferential ring 51 a, 51 b onlyat end 55 a or 55 b, but at no other points in between.

Advantageously, the choice of connection point for first end 55 a andsecond end 55 b can affect the bending and radial stiffnesscharacteristics of mesh 48 used for expandable portion 44. For example,an apex-apex connection (e.g., where first end 55 a is joined to an apexof a first circumferential ring 51 a and second end 55 b is joined to anapex of a second circumferential ring 51 b) generally yield mesh 48 withmore bending flexibility than an apex-side wall connection (e.g., whereone of first and second ends 55 a, 55 b is joined to an apex of acircumferential ring 51 a, 51 b and the other of first and second ends55 a, 55 b is joined to a point along a side of a circumferential ring51 a, 51 b). For example, this arrangement provides a greater distancebetween the points of connection such that a longer structure can beprovided therebetween. This can enable the use of a more flexiblestructure, such as a slender spring-like connector 55, as shown in FIG.15B.

However, the radial stiffness of an expandable portion 44 formed frommesh 48 having apex-apex connectors 55 can be less than the radialstiffness of an expandable portion 44 formed from mesh 48 havingapex-side wall connectors 55. Those of ordinary skill in the art mayappreciate that the width of a circumferential ring 51 can increase atthe apex with the addition of connectors 55, thereby producing higherstrains for a given deformation. Apex-apex connectors 55 can thereforebe thinner than apex-side wall connectors 55 so as to avoid plasticstrains that may result from connections on both the inside and outsideradii of the apex. As a result, the radial stiffness of expandableportion 44 is generally reduced when apex-apex connectors 55 are used informing mesh 48, as compared to apex-side wall connectors 55.

As shown in FIG. 15A, mesh 48 used to form expandable portion 44 caninclude a connector 55 and an axial connector 53. Advantageously, axialconnector 53 can contribute to the axial stiffness of expandable portion44 while connector 55 can contribute to the radial stiffness ofexpandable portion 44.

To retract expandable portion 44 into retainer sheath 60, an axial forcein the proximal direction can be exerted on a member connected to theexpandable portion 44 thus retracting the expandable portion 44 into theretainer sheath 60. This axial force can be advantageously transmittedthrough each circumferential ring 51 via the connectors 55 to pull theexpandable portion 44 into the sheath 60. Furthermore, the relativelocation of connector ends 55 a, 55 b with respect to eachcircumferential ring 51 a, 51 b can facilitate a compact and orderlyretraction of expandable portion 44. For example, in a configuration asshown in FIG. 15B where the connector ends 55 a, 55 b are attached tothe outside apex of one circumferential ring 51 a and the inside apex ofa second circumferential ring 51 b, respectively, the connectors 55 canguide the apexes to nest upon retraction, which can result in a storedconfiguration where the expandable portion 44 is relatively compact, asopposed to a configuration where the apexes are not nested uponretraction.

An alternate embodiment of mesh 48 which is also designed to facilitatethe retraction of expandable portion 44 into retainer sheath 60 is shownin FIG. 16. In accordance with this embodiment, adjacent rings 51 ofmesh 48 are not connected to one another. Rather, each of the outerapexes of a ring 51 is connected to one end 57 a of a connector 57. Theother end 57 b of the connector 57 is not connected to the adjacent ring51, but rather remains unconnected. Connectors 57 are designed to besufficiently soft that the elastomeric coating 50 is able to guide thefree ends 57 b into retainer sheath 60 as expandable portion 44 isretracted, while the connectors 57 themselves act as guidance aids toguide the circumferential rings 51 into the retainer sheath. Connectors57 can either be integrated into the design of mesh 48 or manufacturedas separate pieces, possibly from a different material, and permanentlyattached to the mesh structure. As shown in FIG. 16, end 57 b ofconnector 57 can be configured in the shape of an eyelet.Advantageously, the eyelet can enable a mechanical bond between coating50 and connectors 57. In one arrangement, a mechanical bond is providedthrough the eyelet, e.g., by a process that causes the coating 50 toflow into and bridge the space through the aperture. Structures otherthan eyelets, such as recesses or depressions in the mesh 48 could beused to provide a mechanical bond structure with the coating 50.Alternatively, the coating 50 could have a recess for receiving the mesh48, e.g., a depression having the same shape as the mesh 48, to providea mechanical engagement therebetween. This mechanical bond can bestronger than the surface adhesion bond that would otherwise be presentbetween coating 50 and connector 57 in the absence of the eyelet.

In combination with or as an alternative to designing mesh 48 tofacilitate the retraction of the expandable portion 44 of cannula 40into retainer sheath 60 without the use of a flare or funnel on thesheath, the coating 50 can be altered to facilitate such retraction.Thus, as shown in FIG. 17, some embodiments include a coating- orpolymer-based guidance aid. Referring to FIG. 17, mesh 48 is made from aplurality of rings 51 that are not joined to one another by any directlyattached connectors. Rather, coating 50 includes regions 59 ofadditional elastomeric material, of the same or different compositionand physical characteristics as those of coating 50, applied to selectareas. The regions 59 of additional elastomeric material can add anadditional degree of stiffness to expandable portion 44. The overallflexibility of expandable portion 44 also depends on the geometry andphysical characteristics of the additional regions 59.

The additional elastomeric material in regions 59 can be applied usingthe same solvent casting technique described above in connection withthe formation of polymer ring 145 adjacent inlet 52. Alternatively,regions 59 can be formed separately and jointed to coating 50 in thedesired locations. Regions 59 can extend either fully or intermittentlyalong the length of expandable portion 44 of cannula 40 from proximalend 47 to distal end 45, and can have a variable geometry (e.g., length,width, and/or thickness) and variable properties (e.g., elasticity)along the length of expandable portion 44 to control the cannulaproperties.

In some embodiments, regions 59 can be generally elongate or rib-shapedbetween the proximal and distal ends of expandable portion 44. Regions59 can also have a width sufficient to cover the apexes of rings 51. Asshown in FIG. 17, additional material regions 59 can be applied in oneor more sections along the length of expandable portion 44 in an areaoverlying the apexes of rings 51 and act as guidance aids by guiding therings into retainer sheath 60 during retraction of the expandableportion 44 without the need for a funnel or flare at the end of theretainer sheath. For example, in one embodiment, region 59 is present atthe proximal end of expandable portion 44. Advantageously, in thisembodiment, region 59 is configured to guide the proximal end ofexpandable portion 44 into the retainer sheath. In another embodiment,region 59 is present on a section of expandable portion 44 overlying theimpeller 20. In this embodiment, region 59 can advantageously provideadditional strength to expandable portion 44 to aid in compressing theimpeller 20. This embodiment can also advantageously minimize bulging orother uneven expansion of expandable portion 44 that may be caused byimpeller 20.

As described herein, in some embodiments the design of mesh 48 can benon-uniform throughout at least a portion of the expandable portion 44.Those of ordinary skill in the art may appreciate that, as analternative to or in combination with the regions 59, the non-uniformdesign of mesh 48 can similarly provide variable geometry and/orproperties to the expandable portion 44.

II. Method

The apparatuses described herein can be used in various methods that canbe performed to treat a patient or to prepare an apparatus prior to anytreatment of a patient.

In some of the embodiments discussed above, systems are provided thatenable percutaneous application of heart assist devices that can operateat high flow rates. In particular, certain components are configured tobe actuated between an enlarged operating configuration and a collapsedconfiguration for transluminal delivery and/or withdrawal of the system.

A. Collapsing the System

As discussed herein in connection with FIGS. 6A-8B in connection withthe pump 10, the expandable portion 44 of cannula 40 and the impeller 20positioned therein can be actuated from an operational state to acollapsed state prior to insertion a patient.

In one technique, relative movement is provided between the impeller 20and the housing 46 such that a proximal end of the hub 22 is moved intothe housing 46. As the hub 22 is moved into the housing 46, a proximaledge of a proximal blade 24 is brought into contact with a distal edgeof the housing 46, as shown in FIG. 8B. Further relative movement of theblade 24 causes the blade 24 to move from the deployed configuration tothe stored configuration, as discussed above. In another technique, theimpeller can be stored by moving housing 46 distally over impeller 20 tocompress the blades 24.

To further collapse the pump 10, at least the expandable portion 44 ofthe cannula 40 can be compressed into a low profile state suitable fordelivery. In one technique, the expandable portion 44 is configured tobe collapsed without any distally expanding, e.g., funnel-shaped,devices being required. An example of the cannula 40 in a compressedstate is shown in FIG. 6A.

In one technique, a distal portion of the retainer sheath 60 is advancedover a proximal end of the cannula 40 and is advanced over thenon-expandable portion 42 to a location proximate to the expandableportion 44. As discussed above, the retainer sheath 60 preferably hassufficient radial strength to maintain its shape upon engagement withthe expandable portion 44. This radial rigidity results in expandableportion 44 being compressed upon relative movement of the distal end ofthe retainer sheath 60 and the proximal end of the expandable portion 44toward each other. In some embodiments, a compression tool is used toinsert the expandable portion 44 of cannula 40 into the retainer sheath60.

In one embodiment, the compression tool has a tapered internal diameterportion, such as an internal funnel or cone. This tapered internaldiameter portion has a first end with a large diameter and a second endwith a small diameter. In some embodiments the largest diameter of thetapered internal diameter portion can be generally equal to or largerthan the outer diameter of expandable portion 44 of cannula 40 in itsexpanded configuration. In other embodiments the smallest diameter ofthe tapered internal diameter portion can be generally equal to orsmaller than the inner diameter of the distal end of retainer sheath 60.The compression tool can have a unitary construction, or it can be madeof two or more parts that form the internal tapered shape upon assembly.In use, the compression tool can be placed over or immediately adjacentto the distal portion of the retainer sheath 60 to aid in retraction ofthe expandable portion 44 into the retainer sheath 60. Advantageously, acompression tool made of two or more pieces can be more easily removablefrom the retainer sheath 60.

As discussed above, the expandable portion 44 of cannula 40 isstructured to have sufficient radial strength in the expanded state toconvey fluids between the inlet and outlet and to maintain a volume formovement of the impeller 20. The expandable portion 44 also isconfigured to respond to an axially and distally applied force on anoutside surface of the expandable portion 44 to become radiallycompressed. In one arrangement, the connector 55, 57 is generallyaxially aligned. The connector 55, 57 can be configured such that aforce applied to a proximal end of the connector 55, 57 is transferredthrough the connector to a distal end of the connector. This force isthen applied to a circumferential ring 51 coupled with a distal end ofthe connector 55, 57 to cause the ring 51 to be urged radially inwardlytoward a compressed state.

In another arrangement, the expandable portion 44 is stiffened byproviding axially extending ribs that extend between a proximal end 47and a distal end 45 of the expandable portion. The proximal and distalends 47, 45 can be generally aligned with the direction of movement ofthe retainer sheath 60 relative to the expandable portion 44. Forexample, in one arrangement, the expandable portion 44 includes aplurality of circumferential rings separated from each other by spacesbut coupled together by a flexible material forming a duct, as discussedabove. The circumferential rings 51 can be embedded or enrobed in apolymer sleeve or film, as discussed above. Another region of material59 can be provided on the expandable portion 44 that is adapted to causeradial compression of a portion of the expandable portion 44 that isdisposed distal of the distal end of the retainer sheath 60. Forexample, the second region 59 can be made rigid enough, such as byhaving sufficient thickness, to act as a rib or beam. The rigidity ofthe second region 59 can be such that the relative movement of thedistal end of the sheath 60 over the proximal end of the expandableportion 44 causes a force applied to the proximal end of the rib tocollapse a length of the expandable portion 44 distal of the sheath 60.For example, the force applied by the distal end of the sheath 60 to theexpandable portion 44 can be transferred along the rib by virtue of thestiffness of the rib to apply a force to a circumferential ring locateddistal of the distal end of the sheath 60.

The second region 59 also enables the expandable portion 44 to be guidedinto the distal portion of the sheath 60, which in some embodiments isfixed in shape, e.g., not distally expanded at any point during thecompression of the expandable portion 44. As the expandable portion 44is moved farther proximally relative to the sheath 60, the distalportion of the expandable portion 44 is compressed.

By configuring the expandable portion 44 to be collapsed withoutrequiring a funnel or other distally enlarged structure, the overallprofile of the pump 10 can be reduced. These and other methods forcollapsing the expandable portion 44 can be performed prior to anyapplication of the device to a patient.

As discussed above, the pump 10 can include a vane assembly 120 havingvanes 124 that provide structural integrity to the impeller 20 andexpandable portion 44 when they are deployed. The vanes 124 can becollapsed by any suitable technique, such as those described herein withrespect to the collapse of impeller blades 24. For example, the vanes124 can be collapsed by urging the vane assembly 120 proximally intostorage housing 46. In yet another technique, the pump 10 can becompressed prior to insertion into the body by collapsing the expandableportion 44 of cannula 40 from the proximal end 47 toward the distal end45, such as by advancement of the sheath 60 over the expandable portion44. In this technique, as the expandable portion 44 is collapsed, aconstraining force exerted on the expandable portion 44, e.g., by thesheath 60, can be transmitted to the vane assembly 120, causing thevanes 124 to bend and compress inward towards (e.g., wrap around) hub122. For example, each vane 124 can have a hinge or a portion at whichstress is concentrated adjacent its point of attachment to the hub 122,enabling the vane 124 to be compress circumferentially around the hub122. For example, a portion of the vane 124 near the hub 122 can have areduced cross-sectional area to enhance stress at that location. Thestress can be enhanced to cause a strain in the vane 124 that issufficient to move a distal portion of the vane to a low profileconfiguration upon collapse of the expandable portion 44. Other featuresthat facilitate bending and compressing of the impeller blades 24 canalso be applied to the vane assembly 120 to facilitate bending andcompressing of the vanes 124.

B. Implanting the System

Once the expandable components at the distal end of the pump 10 arecompressed, the pump can be delivered to a treatment site. In onetechnique, the expandable portion 44 of cannula 40 and the retainersheath 60 disposed over the cannula 40 are percutaneously inserted intoa patient's vasculature. Any suitable percutaneous insertion techniquecan be used, such as puncture of the skin and vascular access via theSeldinger technique.

In one technique, the expandable portion 44 and the retainer sheath 60disposed over the expandable portion 44 are percutaneously inserted intoa patient's vasculature over a guidewire 72. Once access is provided tothe vasculature, the guidewire 72 can be advanced into the anatomy. Forexample, the guidewire 72 can be advanced into a femoral artery andalong the aorta to the aortic valve and thereafter into the leftventricle.

Multiple guidewires having various properties can be used, including butnot limited to heavy duty guidewires (e.g., Amplatz, Lunderquist).Advantageously, the use of a heavy duty and/or stiff guidewire canreduce kinking. Where multiple guidewires are used, a first guidewirecan be preassembled into cannula 40 with a distal portion of the firstguidewire exposed distally to the distal end of cannula 40. A secondguidewire can be positioned in the patient as described herein, with aproximal portion of the second guidewire exposed extracorporeal to thepatient. The proximal portion of the second guidewire, e.g., a portionthat is in the patient, can be attached to the distal end of the firstguidewire preassembled into cannula 40, and cannula 40 can be advancedalong two connected guidewires to the desired position. In theseembodiments, the connected first and second guidewires are configured torun coaxially within the drive shaft 26. Once the cannula 40 has beenadvanced to the desired position, the first and second guidewires areremoved prior to activating drive shaft 26. Advantageously, the use oftwo or more guidewires can ease the threading and implantation processof the pump 10.

In certain techniques, the pump 10 can be delivered to a treatment sitewithout the use of a guidewire. For example, once access has beenprovided to the vasculature, the pump 10 can be advanced to thedescending aorta by pushing on the proximal end of the device to advancethe distal end along the peripheral vessels (e.g., femoral or iliac), totrack through a portion of the aorta (e.g., up to and around the aorticarch), to arrive at the aortic valve.

Optionally, the insertion site can be dilated prior to insertion of thecannula 40 and retainer sheath 60. After dilation, the cannula 40 andretainer sheath 60 assembly can be inserted into the vasculature. Inother embodiments, a dilator tip 138 can be used, as shown in FIG. 7B.In FIG. 7B, dilator tip 138 is threaded over the distal end of guidewire 72. When a dilator is used, a separate pre-dilation step is notrequired. Rather, the cannula 40, sheath 60, and dilator tip 138assembly can be inserted into the vasculature.

A distal end of the pump 10 can be advanced over the guidewire 72. Forexample, FIG. 3 illustrates that a cap 134 having an access port 136 canbe provided at the distal end of the expandable portion 44 of cannula40. The access port 136 is axially forward (or distal) of the lumen 130that extends through the vane hub 122. Thus, the proximal end of theguidewire 72 can be advanced into the lumen 130 by moving the wireproximally through the port 136 axially along the length of the cannula40. Thereafter, the pump 10 can be urged distally along the guidewire 72into a position for treating the patient as in FIG. 9. Alternatively,the distal end of the guidewire can be urged into the proximal end pump10 and distally through a lumen formed therein. This technique isparticularly useful for the embodiments discussed where the valve 100 isdisposed in the lumen 70 formed in the hub 22 of the impeller 20.

The pump 10 tracks over the guidewire 72 until the inlet 52 is disposedin a source of blood, such as in a chamber of a patient's heart. Forexample, the inlet 52 can be positioned in the left ventricle 500 andthe outlet can be positioned in the aorta proximal of the aortic valvesuch that blood can be pumped from the ventricle through the conduit andinto the systemic circulatory system. FIG. 9 illustrates that theproximal end of the expandable portion 44 of cannula 40 can bepositioned in the ascending aorta 505. In other embodiments, outlet 54of the expandable portion 44 of cannula 40 can be positioned in theaorta. In one embodiment where blood pump 10 is configured as an LVAD,the inlet 52 can reside in the left ventricle 500 of the heart and theoutlet 54 can reside in the ascending aorta 505. In another embodiment,the expandable portion 44 of cannula 40 can be advanced until theimpeller 20 is centered across the patient's aortic valve. In yet otherembodiments, the cannula 20 can be advanced until the distal inlet 52 ispositioned distally to the aortic valve and the proximal outlet 54 isproximal to the aortic valve. Still in a configuration of the pump wherethe cannula is made to be sufficiently long, the outlet 54 can reside inthe descending aorta while the inlet 52 resides in the left ventricle,where the body of the cannula crosses the aortic valve.

As shown in one embodiment in FIG. 9, the pump 10 extends from theascending aorta 505 into the femoral artery, from which it can exit thepatient's body. Fluoroscopy or other imaging guidance can be used tomonitor advancement and placement of the guidewire 72 and/or cannula 40in the vasculature.

In one embodiment, the impeller 20 can be positioned toward the distalend 45 of cannula 40 which curves around through the aortic valve (notlabeled) into the left ventricle 500 of the heart, while the flexible(and non-expandable) portion 30 of drive shaft 26, coupled to impeller20, extends outside of the body of the patient (e.g., through thefemoral artery) for connection to the drive motor.

C. Deploying the System

In one technique, after the pump 10 has been advanced, the expandableportion 44 can be deployed and expanded, such as by expanding theportion 44. An example of the expandable portion 44 in its expandedstate is shown in FIG. 6B. In one technique, the expandable portion 44of cannula 40 is expanded by retracting the retainer sheath 60, whichallows the expandable portion 44 of cannula 40 to self-expand to thedeployed configuration. The expansion of expandable portion 44 exposesthe inlet 52 and the outlet 54 to blood.

A fluid seal can be provided where cannula 40 crosses a heart valve,e.g., the aortic valve, thereby significantly reducing any blood flowleaking through the heart valve around the outer wall of cannula 40. Theseal can be formed by engagement between the outside wall of the cannula40 and the aortic valve leaflets. In particular, the size of the cannula40 when expanded can be greater than at least one state of the valve,e.g., the fully open state, such that the valve collapses around thecannula 40 in a manner that prevents fluid flow therebetween. Inembodiments where cannula 40 is proximate to the aortic valve, the outersurface of the cannula 40 can be advantageously configured such thatclinically significant abrasion of the aortic valve does not occur uponexpansion. After expansion of expandable portion 44 of cannula 40, theguide wire 72 can be removed.

In one arrangement the, impeller blades 24 and vanes 124 are thereafterreleased from the stored configuration to a deployed configuration afterthe expandable portion of the cannula 44 is expanded. This can beachieved in any suitable way. For example, in one embodiment whereimpeller 20 is housed in the expandable portion 44 of cannula 40, theexpansion of the cannula will remove the constraining force fromimpeller blades 24, and the blades will expand away from hub 22 and intothe use condition simply from the energy stored when the blades arefolded.

Alternatively, in some embodiments, the apparatus can include a storagehousing 46 positioned around the impeller 20, as shown in FIG. 8B. Whereimpeller 20 is housed within storage housing 46, the impeller can bepushed from its stored position by applying a small force to drive shaft26 while holding the housing 46 at a fixed location. Once advanced outof storage housing 46 and into the expandable portion 44 of cannula 40,the blades 24 of impeller 20 can unfold to the use or operationcondition, as shown in FIG. 8A. In one embodiment, the step of releasingthe impeller 20 from the stored configuration to a deployedconfiguration can include axially sliding the storage housing 46 in aproximal direction until at least a portion of the impeller 20 (e.g., aportion including the blades 24) is released from the storage housing46. In another embodiment, the step of releasing impeller 20 from thestored configuration to a deployed configuration can include axiallysliding the impeller 20 in a distal direction until at least a portionof the impeller 20 (e.g., a portion including the blades 24) is releasedfrom the storage housing 46. Hydrodynamic forces and centripetal forcefrom spinning about the hub can also cause impeller blades 24 to furthertransform into their operating configuration when in use.

In embodiments including stator vane assembly 120, expansion ofexpandable portion 44 will also remove the constraining force fromstator vanes 124, thus permitting the stator vanes 124 to be deployedaway from the vane hub 122 and allowing their tips to be disposedadjacent to and in one embodiment, be in contact with an inner surfaceof the cannula. In some embodiments that include a storage housing 46,the steps of deploying the impeller 20 and deploying the vane assembly120 can include moving the impeller 20 and vane assembly 120 togetheraxially in a longitudinally distal direction until at least a portion ofthe impeller 20 and the vane assembly 120 (e.g., blades 24 and vanes124, respectively) are released from the storage housing 46.

D. Operating the System

In some cases, it is desirable to infuse a fluid into the pump 10 afterthe pump has been deployed. For example, the pump 10 can include asystem for collecting, purging, or otherwise managing contaminants ordebris that can be generated by or come into contact with the workingcomponents. As discussed above, the lumen 70 provides access from theproximal end of the pump 10 to the distal end of the impeller 20, asshown in FIG. 2A. The nature of the purge system is not critical, butcan take the form of the system disclosed in FIGS. 2 and 7 andcorresponding text of U.S. Pat. No. 7,731,675, which is herebyincorporated by reference herein. In one technique, as illustrated inFIGS. 8A-8B, the lumen 70 is pressurized with saline prior to operationof the pump 10. As discussed above, the pressurized fluid flows distallyinto the lumen 70 and cause the valve 100 to close when pressure in thelumen 70 exceeds back pressure from the patient's vasculature. Flow ofthe saline or other fluid from the proximal end toward the distal end ofthe lumen can also exit the lumen through the opening 88 to enter thebearing housing 84 to assist in bearing function. In some cases, thefluid can at least partially form a hydrodynamic bearing or can be usedto cool the bearings.

Once the device is positioned and the expandable portion 44 of cannula40 and the impeller 20 are expanded to their respective deployedconditions, the deployment tool can be removed and the relativepositions of the storage housing 46 and/or the sheath 60 can be fixed. Adrive unit can be connected to the blood pump 10 and treatment can beinitiated. The impeller 20 can then be operated to pump blood through atleast a portion of the cannula 40.

In operation, the impeller 20 can rotate about a longitudinal axis ofthe drive shaft 26 to pull fluid in to the expandable portion 44 throughinlet 52 and out through outlet 54. Inlet 52 and struts 56 at the distalend of expandable portion 44 can allow substantially unrestricted flowof blood into blood pump 10, where it is driven by impeller 20proximally through the discharge struts 58 and outlet 54 at the proximalend 47 of expandable portion 44.

In embodiments that include a vane assembly 120, the vane assembly 120can be configured not to rotate along with the impeller 20. As describedherein, the vane assembly 120 advantageously provides lateral stabilityto the impeller 20 and helps to keep the impeller 20 centered withinexpandable portion 44 while in operation. The blood pump 10 can beoperated at any desired rate, such as at a generally cardiac rate or ata generally subcardiac rate. In some embodiments, the blood pump 10 iscapable of operating at a rate in the range of from about 2 L/min toabout 5 L/min under typical physiological pressure, e.g., 90 mm Hg. Inother embodiments, the blood pump 10 can be operated at a rate in therange of from about 1 L/min to about 3 L/min against typicalphysiological pressure, e.g., 90 mm Hg.

E. Removal of the System

Subsequently, the apparatus can be removed from the patient'svasculature. For example, the apparatus can be removed when the patientrecovers and can be weaned from the necessity of using blood pumpintervention.

Removal of the pump 10 can be accomplished in a manner similar to thepreparation of the pump for insertion into the body. For example, theexpandable components of the pump 10 can be compressed in a similarmanner. The impeller 20 can be compressed by urging the impeller 20 intothe storage housing 46 or into non-expandable portion 42 of cannula 40.The expandable portion 44 of cannula 40 can be compressed by urging theproximal end of the expandable portion 44 of cannula 40 into the distalend of the retainer sheath 60.

In some embodiments, a retraction tool can be used for guiding orretracting the expandable portion 44 of cannula 40 into the sheath 60.The retraction tool can be similar in structure to the compression tooland/or deployment tool described herein. As described herein, retainersheath 60 is configured, in one embodiment, to be non-deformable and/ornon-expandable. For example, retainer sheath 60 can have a generallyfixed diameter. The step of urging the expandable portion 44 of cannula40 into retainer sheath 60 can be accomplished in a variety of ways. Forexample, the generally axial rigidity of a guidance aid (e.g., theproximal extents of the connectors 57, axially extending ribs, and/orsecond region 59) can cause the expandable portion 44 of the cannula 40to collapse. In some embodiments, the guidance aids are generally flatlong and narrow in shape and may be aligned axially between the proximaland distal ends of the expandable portion 44 to thus direct theexpandable portion 44 in the axial direction into retainer sheath 60. Inembodiments where the guidance aids connect the adjacent rings 51, theguidance aids can facilitate pulling each ring 51 into the sheath 60. Asthe expandable portion 44 collapses, blood within the expandable portion44 between the inlet 52 and outlet 54 will be flushed distally out ofthe inlet 52.

As described herein with respect to FIGS. 15A, 15B, and 16, theexpandable portion 44 of cannula 40 can include a plurality ofcircumferential rings 51 and a plurality of guidance aids, which can beconfigured as connectors 57 attached to one or more circumferentialrings 51. In these embodiments, the step of guiding the expandableportion 44 of cannula 40 into the sheath 60 can include using theplurality of connectors 57 to guide the expandable portion 44 of cannula40 in a direction generally parallel to each connector 57 and into thesheath 60. Advantageously, this step can be performed without the use ofa funnel and/or with a non-deformable, non-expandable, and/or generallyfixed-diameter sheath 60. By eliminating the need for a distallyenlarged structure like a funnel, the pump 10 can be configured to entera small vessel, such as a vessel accessible close to the surface. As aresult, the pump 10 can applied in the catheterization lab by acardiologist and surgical application is not required. Those of ordinaryskill in the art may appreciate that in use, blood may be likely to poolnear the funnel, increasing the risk of thrombus. Therefore, anotheradvantage of funnel-less removal can be a decreased risk of thrombus.

As shown in FIG. 17 and as described further herein, the expandableportion 44 of cannula 40 can include a plurality of circumferentialrings 51, a first layer 50 of a first polymer at least partially coatingan exterior of the circumferential rings 51, and at least one region 59of a second polymer different from the first polymer that overlies thefirst polymer layer and connects at least a first circumferential ringto a second circumferential ring. In these embodiments, the secondpolymer region 59 can function as a guidance aid for the expandableportion 44. The step of guiding the expandable portion 44 of cannula 40into the sheath 60 can include using the second polymer region 59 toguide the expandable portion 44 of cannula 40 axially into the sheath60. Advantageously, this step can be performed without the use of afunnel and/or with a non-deformable, non-expandable, and/or generallyfixed-diameter sheath 60. Thus, the second polymer region 59 can beconfigured to enable the pump 10 be minimally invasively applied, asdiscussed above.

F. Use as a Right Ventricular Assist Device

In addition to use as an LVAD, the device described herein can also beused as a right ventricular assist device (RVAD) in a manner similar tothat described above. When the device is used as an RVAD, the device canbe inserted into the vasculature via a peripheral vein, such as thefemoral, axillary, subclavian, or the jugular vein, through the venacava and into the patient's heart.

The device can be inserted to a position where the distal end of theexpandable portion 44 of cannula 40 is at a location distal to thepatient's pulmonary valve (e.g., inside the pulmonary artery) and theproximal end of the expandable portion 44 of cannula 40, e.g., is at alocation proximal to the patient's pulmonary valve (e.g., inside theright ventricle). For example, a portion of the proximal end of theexpandable portion 44 of cannula 40 can reside in the patient's rightventricle and the blood flow outlet of the system can be disposed in thepulmonary artery. The inlet of the system, which can be adjacent to theproximal end of the expandable portion 44 of cannula 40, would bedisposed in the patient's right ventricle, right atrium, or vena cava.Advantageously, when the device is used as an RVAD, it can be configuredso that the flow is reversed, such that the conduit at the proximal endof the expandable portion 44 of cannula 40 can operate as a flow inlet,and the conduit at the distal end of the expandable portion 44 ofcannula 40 can operate as a flow outlet. Such a configuration can beachieved by a variety of methods, such as by reversing the pitch of theimpeller blades. In some embodiments, the impeller can operate at areduced flow rate when configured as an RVAD. Advantageously, otherfeatures of the impeller, such as the bearings, drive shaft, drivecable, and the like, may not need to be modified from the LVADconfiguration. Other applications of the device described herein includeproviding additional blood flow to other organs, assisting the heartduring operations and the like.

Applications of the improved fluid pump design described herein are notlimited to ventricular assist devices. The improved cannula and impellerdesigns are useful for any application where a stored configurationhaving a reduced diameter is useful for locating the pump at a desiredlocation. For example, a fluid pump operating underground can beintroduced into a pipe, channel or cavity through an opening of lesserdiameter, and operate at a diameter greater than that of the openingused. Applications of an impeller deploying within an expandable portionof a cannula include a collapsible fire hose with an integral boosterpump, a collapsible propeller, a biomedical pump for a biological fluid,and the like.

Although the invention herein has been described with reference toparticular embodiments, it is to be understood that these embodimentsare merely illustrative of the principles and applications of thepresent invention. It is therefore to be understood that numerousmodifications can be made to the illustrative embodiments and thatoilier arrangements can be devised without departing from the spirit andscope of the present invention as defined by the appended claims.

What is claimed is:
 1. An apparatus for inducing motion of a fluidrelative to the apparatus, comprising: an elongated expandable cannulahaving an inlet end, an outlet end and a diameter expandable to adiameter greater than a delivery diameter, the expandable cannulacomprising: a generally tubular reinforcing matrix; and a polymer atleast partially disposed over an exterior of the reinforcing matrix; animpeller positioned in the elongated expandable cannula; and a retainersheath configured to be withdrawn from the expandable cannula to permitthe expandable cannula to expand and to be advanceable over theexpandable cannula to compress the expandable cannula; wherein theexpandable cannula is configured to be collapsed by the retainer sheathwithout requiring a funnel or other distally enlarged structure.
 2. Theapparatus of claim 1, the impeller having a deployed configuration and astored configuration, the impeller comprising: a hub; and a bladesupported by the hub, the blade having a proximal end attached to thehub and a distal end, the blade in the deployed configuration of theimpeller extending away from the hub, and the blade in the storedconfiguration of the impeller being compressed so as to move the distalend of the blade towards the hub.
 3. An apparatus for inducing motion ofa fluid relative to the apparatus, the apparatus comprising: anelongated cannula having an expandable portion having an inlet end, anoutlet end and a diameter expandable to a diameter greater than adelivery diameter, the expandable portion comprising: a generallytubular reinforcing matrix comprising: a plurality of circumferentialrings each having an undulating pattern including a plurality of apexespointing proximally and defining a plurality of recesses distally; aplurality of connectors connecting one of the apexes pointing proximallyin one of the rings to an adjacent one of the rings; and an impellerpositioned in the elongated cannula.
 4. The apparatus of claim 3,further comprising a connector that extends between a first endconnected to an apex of a first circumferential ring and a second endconnected to an apex of a second circumferential ring.
 5. The apparatusof claim 3, wherein the impeller has a deployed configuration and astored configuration.
 6. The apparatus of claim 5, wherein the impellercomprises a hub and a blade supported by the hub, the blade having aproximal end attached to the hub and a distal end, the blade in thedeployed configuration of the impeller extending away from the hub, andthe blade in the stored configuration of the impeller being compressedso as to move the distal end of the blade towards the hub.
 7. Theapparatus of claim 6, wherein the impeller comprises a plurality ofblades.
 8. The apparatus of claim 3, further comprising a connector thatextends between a first end connected to an apex of a firstcircumferential ring and a second end connected to a side of a secondcircumferential ring.
 9. The apparatus of claim 3, wherein the elongatedcannula comprises a proximal portion and a distal portion, the proximalportion including a conduit having a fixed diameter and the distalportion including the expandable portion.
 10. The apparatus of claim 3,further comprising a valve positioned in the impeller and having a firstcondition for occluding flow of a first fluid through the impeller froma first end to a second end of the impeller, and a second condition foroccluding flow of a second fluid through the impeller from the secondend to the first end.
 11. The apparatus of claim 3, further comprising:a vane assembly positioned in the expandable portion distally of theimpeller and having a deployed configuration and a stored configuration,the vane assembly comprising: a vane hub; and a plurality of vanessupported by the vane hub, each of the vanes having a proximal endattached to the vane hub and a distal end, the vanes in the deployedconfiguration of the vane assembly extending away from the vane hub, andthe in the stored configuration of the vane assembly being compressed soas to move the distal ends of the vanes towards the vane hub; whereinthe vane assembly is connected to the impeller so that the vane assemblymoves with the impeller in a longitudinal direction of the elongatedcannula and so that the vane assembly does not rotate with the impeller.12. The apparatus of claim 3, further comprising a hub axially offsetfrom the impeller, the hub having a plurality of members extendingradially therefrom.
 13. The apparatus of claim 12, wherein the radiallyextending members comprise a plurality of vanes.
 14. The apparatus ofclaim 13, wherein the hub and vanes are disposed distal of the impeller.15. The apparatus of claim 12, wherein the radially extending membersfoldable against the hub from which they extend.
 16. The apparatus ofclaim 3, the apparatus further comprising: a sheath having a generallynon-expanding distal portion, wherein the expandable portion of thecannula comprises a proximal end, a distal end, a duct extending betweenthe proximal and distal ends, and wherein the distal portion of thesheath is configured to move relative to the proximal end of theexpandable portion.
 17. The apparatus of claim 16, wherein, whenrelative motion is provided between the distal portion of the sheath andthe proximal end of the expandable portion, the distal portion of theretainer sheath applies a force having a radial component to a proximalend of one of the connectors to induce radial collapse of a distalregion of the duct to facilitate collapse of the expandable portion intothe sheath.
 18. The apparatus of claim 17, further comprising apolymeric rib structure disposed axially along the duct.
 19. Theapparatus of claim 17, wherein the apparatus comprises a spacing devicedisposed adjacent to the impeller for maintaining an operatingseparation between the impeller and the duct.
 20. The apparatus of claim3, further comprising a valve positioned in a lumen accessible throughthe impeller and having a first condition for occluding flow of a fluidand a second configuration for permitting a guidewire to passtherethrough.
 21. The apparatus of claim 12, wherein the radiallyextending members are configured to contact an inner wall of theexpandable portion to control a gap between the impeller and the wall ofthe expandable portion.
 22. The apparatus of claim 3, further comprisinga plurality of vanes disposed downstream of the impeller.
 23. Theapparatus of claim 22, wherein the vanes are disposed proximally of theimpeller.
 24. The apparatus of claim 3, further comprising membersdisposed downstream of the impeller having a foil type cross-section.25. An apparatus for inducing motion of a fluid relative to theapparatus, comprising: an elongated cannula having an expandable portionhaving an inlet end, an outlet end and a diameter expandable to adiameter greater than a delivery diameter, the expandable portioncomprising: a generally tubular reinforcing matrix; a layer of a firstpolymer at least partially coating an exterior of the reinforcingmatrix, the reinforcing matrix including a plurality of circumferentialrings each having an undulating pattern including a plurality of apexespointing toward the outlet end and defining a plurality of recessespointing toward the inlet end; the reinforcing matrix including memberscoupled at distal ends with a corresponding apexes, the members havingproximal ends disposed proximal of the corresponding apex; and at leastone region of a second polymer different from the first polymer thatoverlies the first polymer layer and extends between one of the apexespointing toward the outlet end in one of the rings and at least oneother ring; and an impeller positioned in the elongated cannula.
 26. Theapparatus of claim 25, wherein the impeller has a deployed configurationand a stored configuration, the impeller comprising a hub and a bladesupported by the hub, the blade having a proximal end attached to thehub and a distal end, the blade in the deployed configuration of theimpeller extending away from the hub, and the blade in the storedconfiguration of the impeller being compressed so as to move the distalend of the blade towards the hub.